Financial Fact Finder
Financial Fact Finder
Stein Wealth Advisors, LLC Lake View Square 4000 Washington Rd, Ste 101 McMurray, PA 15317-2534 Phone: 724.260.0491 Fax: 724.260.0674 [email protected] www.steinwealth.com
Please bring copies of the following to each meeting:
❏ Pension estimate or projection statement ❏ 401(k) statement - include investment options ❏ 403(b) statement ❏ Social Security statement ❏ Stock option statement ❏ Deferred compensation statement ❏ Form 1040 of last year’s tax return ❏ Current paystubs ❏ Education account statements (529 plans, custodial accounts, UGMA/UTMA accounts) ❏ IRA, Roth IRA, Annuity or any miscellaneous investment statements ❏ Bank account statements: checking, savings, money manager, certificate of deposit ❏ Liability statements: mortgage, credit cards, car loans, student loans, any debt statements ❏ Updated life insurance statement or policy details ❏ Disability insurance statements ❏ Long term care statements ❏ Will(s) ❏ Employee Benefit Handbook(s) Questions for Melissa
Financial Fact Finder
www.steinwealth.com
PAGE 1
Personal Data Please complete both columns, unless you are single, widowed, or divorced.
Client A - Personal Information First Name
Middle
Nickname
Last
First Name
Date of Birth
Social Security Number
Citizenship:
Client B - Personal Information
Middle
Nickname
❏ Male ❏ Female
❏ U.S. Citizen ❏ Resident Alien ❏ Non-Resident Alien
Last
Date of Birth
Social Security Number
Citizenship:
❏ Male ❏ Female
❏ U.S. Citizen ❏ Resident Alien ❏ Non-Resident Alien
Place of Birth
Mother’s Maiden Name
Place of Birth
Mother’s Maiden Name
Driver’s License Number
State
Driver’s License Number
State
Issue Date
Expiration Date
Issue Date
Home Street Address
City
Expiration Date
Home Street Address
State
Zip Code
Personal Email
Home Telephone
City
State
Zip Code
Personal Email
Cell Phone
Home Telephone
Cell Phone
Marital Status:
Marital Status:
❏ Single ❏ Married ❏ Domestic Partner ❏ Widowed ❏ Divorced
❏ Single ❏ Married ❏ Domestic Partner ❏ Widowed ❏ Divorced
Anniversary Date (if married) :
Client A - Employment Information Job Title
Employer
Job Title
Employer Street Address
City
Employer
Employer Street Address
State
Work Email
Work Telephone
Client B - Employment Information
Zip Code
City
State
Zip Code
Work Email
Work Cell
Financial Fact Finder
Work Telephone
Work Cell
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PAGE 2
Personal Data (Continued) Affiliations Are you (or a member of your immediate family) a director, 10% shareholder or policymaking officer of a publicly traded company?
❏ Yes ❏ No
If yes, Company Name:
Are you (or a member of your immediate family) a registered representative of a broker-dealer?
❏ Yes ❏ No
If yes, specify Firm Name:
Are you (or a member of your immediate family) employed by or otherwise affiliated with FINRA or any broker-dealer?
❏ Yes ❏ No
If yes, specify Firm Name:
Are you (or a member of your immediate family) a politically exposed person in non-U.S. country?
❏ Yes ❏ No
If yes, specify
Account Profile Annual Income
Estimated Net Worth
❏ $ 0 – 29,000 ❏ $ 30,000 – 49,999 ❏ $ 50,000 – 74,999 ❏ $ 75,000 – 99,999 ❏ $ 100,000 – 149,999 ❏ $ 150,000 – 249,999 ❏ $ 250,000 – 399,999 ❏ $ 400,000 – Over
Portfolio Objectives
❏ $ 0 – 74,999 ❏ $ 75,000 – 99,999 ❏ $ 100,000 – 149,999 ❏ $ 150,000 – 249,999 ❏ $ 250,000 – 499,999 ❏ $ 500,000 – 999,999 ❏ $ 1,000,000 – 2,999,999 ❏ $ 3,000,000 – Over
Portfolio Time Horizon
Check all that apply
❏ < 4 Years ❏ 4-8 Years ❏ > 8 Years
❏ Income ❏ Growth ❏ Total Return ❏ Tax Deferral
Federal tax Bracket
❏ %
Investment Experience? ❏ Yes ❏ No
❏ Stocks
yrs
❏ Bonds
yrs
❏ Mutual Funds
yrs
❏ DDP’s
❏ Annuities
yrs
❏ REIT’s
yrs
❏ Other (identify)
yrs yrs
Interview Questions With whom do you consult before making important financial decisions?
Who prepares your tax forms?
Are you obligated to do business with anyone else?
Financial Fact Finder
www.steinwealth.com
PAGE 3
Interview Questions (continued) Have you worked with a financial professional in the past? If yes, please provide their name:
First Name
❏ Yes ❏ No
Last
How was the experience?
What are your expectations from me?
What fears or potential pitfalls would you like to avoid?
Dependents
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
Do you plan on having additional children? ❏ Yes ❏ No Are there any immediate or long term financial obligations for supporting parents or dependents?
❏ Yes ❏ No
If yes, please explain:
Do any of your dependents have special needs? If so, which child(ren)?
Financial Fact Finder
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PAGE 4
Financial Planning Client A
Client B
Annual Salary
Annual Bonus
Annual Salary
Do you foresee a significant change in your income within the next 2 years? ❏ Yes ❏ No
Annual Bonus
Do you foresee a significant change in your income within the next 2 years? ❏ Yes ❏ No
❏ Yes ❏ No Do you have a will and/or a trust now? If yes, when was it last updated? ❏ Yes ❏ No Are you expecting to receive money or property from an inheritance, a gift, judgment or lawsuit or other? If yes, please explain:
❏ Yes ❏ No Are all children legally yours, either natural or legally adopted? ❏ Yes ❏ No Are there any stepchildren in your family? If so, how many? ❏ Yes ❏ No Do you have any children under the age of 18? If so, how many? ❏ Yes ❏ No Do you have any children or grandchildren with special needs or for whom you would like to make special provisions?
❏ Yes ❏ No Do you make any charitable donations? If so, to whom?
❏ Yes ❏ No Have you or your spouse been married before? If yes, and there are children by a previous marriage, please list their names and ages:
First Name
Middle
Last
Date of Birth
Age
First Name
Middle
Last
Date of Birth
Age
First Name
Middle
Last
Date of Birth
Age
First Name
Middle
Last
Date of Birth
Age
❏ Yes ❏ No Have you entered into a prenuptial agreement? If yes, please provide a copy. ❏ Yes ❏ No Are both of you U.S. citizens? If no, please specify:
❏ Yes ❏ No Have you and/or your spouse made any gifts to any one individual in a calendar year in excess of $13,000 or $26,000 jointly? If so, please explain and list the years:
Financial Fact Finder
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PAGE 5
Retirement Objectives Client A Target Retirement Age (what age do you want to retire?
Client B Target Retirement Age (what age do you want to retire?
What monthly income amount do you want to have in retirement (after taxes)?
What monthly income amount do you want to have in retirement (after taxes)?
What milestones do you see in the future for your Retirement or Financial Independence (i.e., purchase a new home, relocate, remodel the kitchen, travel more, enjoy a comfortable retirement, etc.)
Where do you dream of going? (Did you know that the 2010 average U.S. vacation cost per day for food and lodging for two people was $244?)
What destination? (United States, other countries, historical sites, places from your roots, or homes of friends and family)
How do you want to make a difference to family, community, an organization or friends? Sometimes dreams and goals can include helping others. Think about the people, communities and organizations that matter to you. How do you want to support them now and in the future? Think BIG!
Family (fund education, instill values or teach personal skills?)
Community/Organization (volunteer at school, serve on a board, support outreach activities, raise funds, donate money or leave a legacy?)
Friends (form support groups, be a mentor or volunteer together?)
Other comments:
Financial Fact Finder
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PAGE 6
Retirement Income Sources Client A
Client B
Do you have pension benefits from a current or past employer? ❏ Yes * ❏ No
Do you have pension benefits from a current or past employer? ❏ Yes * ❏ No
* Please attach a statement of benefits, payment options, and plan documents
* Please attach a statement of benefits, payment options, and plan documents
Pension monthly benefit at age 65?
Pension monthly benefit at age 65?
Are you entitled to Social Security benefits?
Are you entitled to Social Security benefits?
❏ Yes * ❏ No
❏ Yes * ❏ No
* Please attach a printout from www.ssa.gov
Benefit amount: Age 62
* Please attach a printout from www.ssa.gov
Benefit amount:
Age 66 (Full Retirement Age)
Age 70
Age 62
Age 66 (Full Retirement Age)
Age 70
Asset Information Banking: Checking, Savings, Money Market, CDs Sample: Checking
PNC Bank
$5,000
Asset Type Institution Name Current Balance
$100 Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Financial Fact Finder
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
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PAGE 7
Asset Information (Continued) Investments: 529 Plans, Savings Bonds, 401(k), 403(b), SEP IRA’s, 457 Plans, Retirement Saving Plans, Roth IRA’s, Traditional/ Rollover IRA’s, Annuities, UGMA/UTMA, Stock Options, Restricted Stocks, SAR’s, Non-Retirement Investment Accounts, etc.
Sample 1: Roth IRA
Vanguard
$5,000
Asset Type Institution Name Current Balance
Sample 2:
401(k)
Fidelity
$50
N/A
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
$20,000 $300
Ownership:
❏ Individual ❏ Joint
4%
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Ownership:
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Ownership:
Ownership:
Ownership:
Ownership:
Ownership:
Ownership:
❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint
Real Property: Real Estate, Cars, Jewelry, Boats, etc. Sample: Home Residence
$350,000
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Financial Fact Finder
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PAGE 8
Liabilities Loans and Liabilities: Mortgage, Home Equity Loan, Car Loan, Student Loan, Credit Cards, etc. Sample: Mortgage
Wells Fargo
$1,547
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Financial Fact Finder
4.5%
$205,000
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PAGE 9
Protection Planning Life Insurance Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Disability Insurance Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Long Term Care Insurance Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Other Insurance Insurance Company
Insurance Type
Insured’s Name
Owner
Coverage
Annual Premium
Insurance Company
Insurance Type
Insured’s Name
Owner
Coverage
Annual Premium
Financial Fact Finder
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PAGE 10
Health Status Client A
Client B
Please rate your overall health status.
Please rate your overall health status.
❏ Excellent ❏ Good
❏ Excellent ❏ Good
❏ Fair ❏ Poor
Are you a smoker?
Are you a smoker?
❏ Yes ❏ No
❏ Yes ❏ No
Notes:
Notes:
❏ Fair ❏ Poor
Education Objectives Child 1
Child 2
Child 3
Child 4
Name of Child
Name of Child
Name of Child
Name of Child
University, College or School of Choice
University, College or School of Choice
University, College or School of Choice
University, College or School of Choice
Expected Annual Tuition and Living Expenses Per Year
Expected Annual Tuition and Living Expenses Per Year
Expected Annual Tuition and Living Expenses Per Year
Expected Annual Tuition and Living Expenses Per Year
Expected Year to Enter College
Expected Year to Enter College
Expected Year to Enter College
Expected Year to Enter College
Number of Years of Education:
Number of Years of Education:
Number of Years of Education:
Number of Years of Education:
Undergraduate
Undergraduate
Undergraduate
Undergraduate
Graduate
Graduate
Graduate
Graduate
Do you plan to send your child(ren) to private school before college?
Do you plan to send your child(ren) to private school before college?
Do you plan to send your child(ren) to private school before college?
Do you plan to send your child(ren) to private school before college?
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
If yes, please provide the annual tuition amount?
If yes, please provide the annual tuition amount?
If yes, please provide the annual tuition amount?
If yes, please provide the annual tuition amount?
Financial Fact Finder
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PAGE 11
Investment Objectives My primary investment objective is to:
❏ Protect Capital I am a conservative investor. Risk must be low. I am prepared to accept low returns in an attempt to protect capital.
❏ Maintain Wealth I am seeking better than average return, but desire low risk in my investment portfolio. I want to protect the wealth I have accumulated. I am willing to consider growth investments to cope with the negative effects inflation can have on my investment portfolio.
❏ Meet Investment Objectives I am a moderate investor who wants a balanced portfolio to work towards medium to long term financial objectives. I require an
investment strategy that over time can provide returns to meet those objectives. Calculated risks will be acceptable in an attempt to meet those objectives.
❏ Growth Oriented I am an assertive investor, probably earning sufficient income to invest most funds for capital growth. I am prepared to accept some potential losses and moderate risks. My primary concern is to accumulate assets over the medium to long term. I desire a balanced portfolio, but more aggressive investments may be included.
❏ Aggressively Build Long-Term Wealth I am an aggressive investor prepared to compromise safety of principle to pursue potentially high long term returns. My investment choices are diverse, and I realize they carry with them a high level of risk. Security of capital is secondary to the potential for wealth accumulation.
What do you expect your total income and investment earnings to do over the next 10 years?
❏ Decline Significantly ❏ Decrease somewhat
❏ Stay the same
❏ Improve
❏ Increase substantially
If you could increase your chances of improving your investment returns by increasing the investments that may fluctuate in value over time, such as stocks, and take on more risk in your portfolio, would you:
❏ ❏ ❏ ❏
Be unlikely to take more risk? Be willing to take a little more risk with some of my overall portfolio? Be willing to take a lot more risk with some of my overall portfolio? Be willing to take a lot more risk with my entire portfolio?
Which of the following best describes the monitoring of your investments?
❏ I do not monitor my investments, nor do I have them reviewed. ❏ I monitor, or have my investments reviewed periodically but not regularly. ❏ I monitor, or have my investments reviewed regularly, at least once per year. When it comes to investing, I would describe myself as:
❏ Having little to no experience. ❏ Having some experience in managed investments such as mutual funds and/or variable annuities. ❏ E xperienced in managed investments such as mutual funds and/or variable annuities and/or individual stocks and bonds.
❏ Very experienced in a broad range of investments.
Financial Fact Finder
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PAGE 12
Investment Objectives (Continued) Use the following graph to answer the next two questions: $110,000 $100,000
$90,000
$80,000
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
0
$102,250 $87,320 $74,425
Portfolio Value
Period 1
Period 2
If your portfolio, valued at $100,000, declined in value to $78,000 within a one-year period, as Period 1 represents (i.e., down 22%), what would you most likely do?
❏ ❏ ❏ ❏
Sell all the positions and move the money to safer investments. Sell only the losing investments. Sell nothing and wait for the markets to recover. Buy more as the losing investments may represent opportunity
If the above portfolio declined by an additional 10% to $70,200 the following year, what would you most likely do?
❏ ❏ ❏ ❏
Sell all the positions and move the money to safer investments. Sell only the losing investments. Sell nothing and wait for the markets to recover. Buy more as the losing investments may represent opportunity
What is your investment time horizon: i.e., when will you need most of your invested money?
❏ 1 year - 3 years
❏ 4 years - 9 years
Financial Fact Finder
❏ 10 years - 15 years
❏ Over 15 years
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PAGE 13
Stein Wealth Advisors, LLC Lake View Square 4000 Washington Rd, Ste 101 McMurray, PA 15317-2534 Phone: 724.260.0491 Fax: 724.260.0674 [email protected] www.steinwealth.com
Please bring copies of the following to each meeting:
❏ Pension estimate or projection statement ❏ 401(k) statement - include investment options ❏ 403(b) statement ❏ Social Security statement ❏ Stock option statement ❏ Deferred compensation statement ❏ Form 1040 of last year’s tax return ❏ Current paystubs ❏ Education account statements (529 plans, custodial accounts, UGMA/UTMA accounts) ❏ IRA, Roth IRA, Annuity or any miscellaneous investment statements ❏ Bank account statements: checking, savings, money manager, certificate of deposit ❏ Liability statements: mortgage, credit cards, car loans, student loans, any debt statements ❏ Updated life insurance statement or policy details ❏ Disability insurance statements ❏ Long term care statements ❏ Will(s) ❏ Employee Benefit Handbook(s) Questions for Melissa
Financial Fact Finder
www.steinwealth.com
PAGE 1
Personal Data Please complete both columns, unless you are single, widowed, or divorced.
Client A - Personal Information First Name
Middle
Nickname
Last
First Name
Date of Birth
Social Security Number
Citizenship:
Client B - Personal Information
Middle
Nickname
❏ Male ❏ Female
❏ U.S. Citizen ❏ Resident Alien ❏ Non-Resident Alien
Last
Date of Birth
Social Security Number
Citizenship:
❏ Male ❏ Female
❏ U.S. Citizen ❏ Resident Alien ❏ Non-Resident Alien
Place of Birth
Mother’s Maiden Name
Place of Birth
Mother’s Maiden Name
Driver’s License Number
State
Driver’s License Number
State
Issue Date
Expiration Date
Issue Date
Home Street Address
City
Expiration Date
Home Street Address
State
Zip Code
Personal Email
Home Telephone
City
State
Zip Code
Personal Email
Cell Phone
Home Telephone
Cell Phone
Marital Status:
Marital Status:
❏ Single ❏ Married ❏ Domestic Partner ❏ Widowed ❏ Divorced
❏ Single ❏ Married ❏ Domestic Partner ❏ Widowed ❏ Divorced
Anniversary Date (if married) :
Client A - Employment Information Job Title
Employer
Job Title
Employer Street Address
City
Employer
Employer Street Address
State
Work Email
Work Telephone
Client B - Employment Information
Zip Code
City
State
Zip Code
Work Email
Work Cell
Financial Fact Finder
Work Telephone
Work Cell
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PAGE 2
Personal Data (Continued) Affiliations Are you (or a member of your immediate family) a director, 10% shareholder or policymaking officer of a publicly traded company?
❏ Yes ❏ No
If yes, Company Name:
Are you (or a member of your immediate family) a registered representative of a broker-dealer?
❏ Yes ❏ No
If yes, specify Firm Name:
Are you (or a member of your immediate family) employed by or otherwise affiliated with FINRA or any broker-dealer?
❏ Yes ❏ No
If yes, specify Firm Name:
Are you (or a member of your immediate family) a politically exposed person in non-U.S. country?
❏ Yes ❏ No
If yes, specify
Account Profile Annual Income
Estimated Net Worth
❏ $ 0 – 29,000 ❏ $ 30,000 – 49,999 ❏ $ 50,000 – 74,999 ❏ $ 75,000 – 99,999 ❏ $ 100,000 – 149,999 ❏ $ 150,000 – 249,999 ❏ $ 250,000 – 399,999 ❏ $ 400,000 – Over
Portfolio Objectives
❏ $ 0 – 74,999 ❏ $ 75,000 – 99,999 ❏ $ 100,000 – 149,999 ❏ $ 150,000 – 249,999 ❏ $ 250,000 – 499,999 ❏ $ 500,000 – 999,999 ❏ $ 1,000,000 – 2,999,999 ❏ $ 3,000,000 – Over
Portfolio Time Horizon
Check all that apply
❏ < 4 Years ❏ 4-8 Years ❏ > 8 Years
❏ Income ❏ Growth ❏ Total Return ❏ Tax Deferral
Federal tax Bracket
❏ %
Investment Experience? ❏ Yes ❏ No
❏ Stocks
yrs
❏ Bonds
yrs
❏ Mutual Funds
yrs
❏ DDP’s
❏ Annuities
yrs
❏ REIT’s
yrs
❏ Other (identify)
yrs yrs
Interview Questions With whom do you consult before making important financial decisions?
Who prepares your tax forms?
Are you obligated to do business with anyone else?
Financial Fact Finder
www.steinwealth.com
PAGE 3
Interview Questions (continued) Have you worked with a financial professional in the past? If yes, please provide their name:
First Name
❏ Yes ❏ No
Last
How was the experience?
What are your expectations from me?
What fears or potential pitfalls would you like to avoid?
Dependents
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
First Name
Middle
Last
Date of Birth
Social Security Number
Do you plan on having additional children? ❏ Yes ❏ No Are there any immediate or long term financial obligations for supporting parents or dependents?
❏ Yes ❏ No
If yes, please explain:
Do any of your dependents have special needs? If so, which child(ren)?
Financial Fact Finder
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PAGE 4
Financial Planning Client A
Client B
Annual Salary
Annual Bonus
Annual Salary
Do you foresee a significant change in your income within the next 2 years? ❏ Yes ❏ No
Annual Bonus
Do you foresee a significant change in your income within the next 2 years? ❏ Yes ❏ No
❏ Yes ❏ No Do you have a will and/or a trust now? If yes, when was it last updated? ❏ Yes ❏ No Are you expecting to receive money or property from an inheritance, a gift, judgment or lawsuit or other? If yes, please explain:
❏ Yes ❏ No Are all children legally yours, either natural or legally adopted? ❏ Yes ❏ No Are there any stepchildren in your family? If so, how many? ❏ Yes ❏ No Do you have any children under the age of 18? If so, how many? ❏ Yes ❏ No Do you have any children or grandchildren with special needs or for whom you would like to make special provisions?
❏ Yes ❏ No Do you make any charitable donations? If so, to whom?
❏ Yes ❏ No Have you or your spouse been married before? If yes, and there are children by a previous marriage, please list their names and ages:
First Name
Middle
Last
Date of Birth
Age
First Name
Middle
Last
Date of Birth
Age
First Name
Middle
Last
Date of Birth
Age
First Name
Middle
Last
Date of Birth
Age
❏ Yes ❏ No Have you entered into a prenuptial agreement? If yes, please provide a copy. ❏ Yes ❏ No Are both of you U.S. citizens? If no, please specify:
❏ Yes ❏ No Have you and/or your spouse made any gifts to any one individual in a calendar year in excess of $13,000 or $26,000 jointly? If so, please explain and list the years:
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Retirement Objectives Client A Target Retirement Age (what age do you want to retire?
Client B Target Retirement Age (what age do you want to retire?
What monthly income amount do you want to have in retirement (after taxes)?
What monthly income amount do you want to have in retirement (after taxes)?
What milestones do you see in the future for your Retirement or Financial Independence (i.e., purchase a new home, relocate, remodel the kitchen, travel more, enjoy a comfortable retirement, etc.)
Where do you dream of going? (Did you know that the 2010 average U.S. vacation cost per day for food and lodging for two people was $244?)
What destination? (United States, other countries, historical sites, places from your roots, or homes of friends and family)
How do you want to make a difference to family, community, an organization or friends? Sometimes dreams and goals can include helping others. Think about the people, communities and organizations that matter to you. How do you want to support them now and in the future? Think BIG!
Family (fund education, instill values or teach personal skills?)
Community/Organization (volunteer at school, serve on a board, support outreach activities, raise funds, donate money or leave a legacy?)
Friends (form support groups, be a mentor or volunteer together?)
Other comments:
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Retirement Income Sources Client A
Client B
Do you have pension benefits from a current or past employer? ❏ Yes * ❏ No
Do you have pension benefits from a current or past employer? ❏ Yes * ❏ No
* Please attach a statement of benefits, payment options, and plan documents
* Please attach a statement of benefits, payment options, and plan documents
Pension monthly benefit at age 65?
Pension monthly benefit at age 65?
Are you entitled to Social Security benefits?
Are you entitled to Social Security benefits?
❏ Yes * ❏ No
❏ Yes * ❏ No
* Please attach a printout from www.ssa.gov
Benefit amount: Age 62
* Please attach a printout from www.ssa.gov
Benefit amount:
Age 66 (Full Retirement Age)
Age 70
Age 62
Age 66 (Full Retirement Age)
Age 70
Asset Information Banking: Checking, Savings, Money Market, CDs Sample: Checking
PNC Bank
$5,000
Asset Type Institution Name Current Balance
$100 Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Asset Type Institution Name Current Balance
Monthly Savings Amount
Financial Fact Finder
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
Ownership:
❏ Individual ❏ Joint
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
(Your contributions per month)
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Asset Information (Continued) Investments: 529 Plans, Savings Bonds, 401(k), 403(b), SEP IRA’s, 457 Plans, Retirement Saving Plans, Roth IRA’s, Traditional/ Rollover IRA’s, Annuities, UGMA/UTMA, Stock Options, Restricted Stocks, SAR’s, Non-Retirement Investment Accounts, etc.
Sample 1: Roth IRA
Vanguard
$5,000
Asset Type Institution Name Current Balance
Sample 2:
401(k)
Fidelity
$50
N/A
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
$20,000 $300
Ownership:
❏ Individual ❏ Joint
4%
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Ownership:
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Asset Type Institution Name Current Balance
Monthly Savings Amount
Employer Contributions
(Your contributions per month)
(Match Dollar Amount or Percentage)
Ownership:
Ownership:
Ownership:
Ownership:
Ownership:
Ownership:
❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint ❏ Individual ❏ Joint
Real Property: Real Estate, Cars, Jewelry, Boats, etc. Sample: Home Residence
$350,000
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
Asset Type
Current Value
Ownership:
❏ Individual ❏ Joint
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Liabilities Loans and Liabilities: Mortgage, Home Equity Loan, Car Loan, Student Loan, Credit Cards, etc. Sample: Mortgage
Wells Fargo
$1,547
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Liability Name
Institution Name
Minimum Monthly Payment Interest Rate % Current Balance
Financial Fact Finder
4.5%
$205,000
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PAGE 9
Protection Planning Life Insurance Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Insurance Company
Insured’s Name
Death Benefit Annual Premium Cash Value
❏ Term ❏ Whole Life ❏ Universal Life
Disability Insurance Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Long Term Care Insurance Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Insurance Company
Insured’s Name
Benefit Period
Monthly Benefit
Annual Premium
Waiting Period
Other Insurance Insurance Company
Insurance Type
Insured’s Name
Owner
Coverage
Annual Premium
Insurance Company
Insurance Type
Insured’s Name
Owner
Coverage
Annual Premium
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PAGE 10
Health Status Client A
Client B
Please rate your overall health status.
Please rate your overall health status.
❏ Excellent ❏ Good
❏ Excellent ❏ Good
❏ Fair ❏ Poor
Are you a smoker?
Are you a smoker?
❏ Yes ❏ No
❏ Yes ❏ No
Notes:
Notes:
❏ Fair ❏ Poor
Education Objectives Child 1
Child 2
Child 3
Child 4
Name of Child
Name of Child
Name of Child
Name of Child
University, College or School of Choice
University, College or School of Choice
University, College or School of Choice
University, College or School of Choice
Expected Annual Tuition and Living Expenses Per Year
Expected Annual Tuition and Living Expenses Per Year
Expected Annual Tuition and Living Expenses Per Year
Expected Annual Tuition and Living Expenses Per Year
Expected Year to Enter College
Expected Year to Enter College
Expected Year to Enter College
Expected Year to Enter College
Number of Years of Education:
Number of Years of Education:
Number of Years of Education:
Number of Years of Education:
Undergraduate
Undergraduate
Undergraduate
Undergraduate
Graduate
Graduate
Graduate
Graduate
Do you plan to send your child(ren) to private school before college?
Do you plan to send your child(ren) to private school before college?
Do you plan to send your child(ren) to private school before college?
Do you plan to send your child(ren) to private school before college?
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
❏ Yes ❏ No
If yes, please provide the annual tuition amount?
If yes, please provide the annual tuition amount?
If yes, please provide the annual tuition amount?
If yes, please provide the annual tuition amount?
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Investment Objectives My primary investment objective is to:
❏ Protect Capital I am a conservative investor. Risk must be low. I am prepared to accept low returns in an attempt to protect capital.
❏ Maintain Wealth I am seeking better than average return, but desire low risk in my investment portfolio. I want to protect the wealth I have accumulated. I am willing to consider growth investments to cope with the negative effects inflation can have on my investment portfolio.
❏ Meet Investment Objectives I am a moderate investor who wants a balanced portfolio to work towards medium to long term financial objectives. I require an
investment strategy that over time can provide returns to meet those objectives. Calculated risks will be acceptable in an attempt to meet those objectives.
❏ Growth Oriented I am an assertive investor, probably earning sufficient income to invest most funds for capital growth. I am prepared to accept some potential losses and moderate risks. My primary concern is to accumulate assets over the medium to long term. I desire a balanced portfolio, but more aggressive investments may be included.
❏ Aggressively Build Long-Term Wealth I am an aggressive investor prepared to compromise safety of principle to pursue potentially high long term returns. My investment choices are diverse, and I realize they carry with them a high level of risk. Security of capital is secondary to the potential for wealth accumulation.
What do you expect your total income and investment earnings to do over the next 10 years?
❏ Decline Significantly ❏ Decrease somewhat
❏ Stay the same
❏ Improve
❏ Increase substantially
If you could increase your chances of improving your investment returns by increasing the investments that may fluctuate in value over time, such as stocks, and take on more risk in your portfolio, would you:
❏ ❏ ❏ ❏
Be unlikely to take more risk? Be willing to take a little more risk with some of my overall portfolio? Be willing to take a lot more risk with some of my overall portfolio? Be willing to take a lot more risk with my entire portfolio?
Which of the following best describes the monitoring of your investments?
❏ I do not monitor my investments, nor do I have them reviewed. ❏ I monitor, or have my investments reviewed periodically but not regularly. ❏ I monitor, or have my investments reviewed regularly, at least once per year. When it comes to investing, I would describe myself as:
❏ Having little to no experience. ❏ Having some experience in managed investments such as mutual funds and/or variable annuities. ❏ E xperienced in managed investments such as mutual funds and/or variable annuities and/or individual stocks and bonds.
❏ Very experienced in a broad range of investments.
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PAGE 12
Investment Objectives (Continued) Use the following graph to answer the next two questions: $110,000 $100,000
$90,000
$80,000
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
0
$102,250 $87,320 $74,425
Portfolio Value
Period 1
Period 2
If your portfolio, valued at $100,000, declined in value to $78,000 within a one-year period, as Period 1 represents (i.e., down 22%), what would you most likely do?
❏ ❏ ❏ ❏
Sell all the positions and move the money to safer investments. Sell only the losing investments. Sell nothing and wait for the markets to recover. Buy more as the losing investments may represent opportunity
If the above portfolio declined by an additional 10% to $70,200 the following year, what would you most likely do?
❏ ❏ ❏ ❏
Sell all the positions and move the money to safer investments. Sell only the losing investments. Sell nothing and wait for the markets to recover. Buy more as the losing investments may represent opportunity
What is your investment time horizon: i.e., when will you need most of your invested money?
❏ 1 year - 3 years
❏ 4 years - 9 years
Financial Fact Finder
❏ 10 years - 15 years
❏ Over 15 years
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PAGE 13
